Increased Incidence of Bronchopulmonary Fistulas Complicating Pediatric Pneumonia

Background: The frequency of complicated pneumococcal disease, including necrotizing pneumonia, has increased over the last decade. During 2008-2009, we noted an increase in the number of children whose empyema was complicated by the development of a bronchopleural fistula and air leak. We studied these children to see if there was an associated cause. Methods: This was a retrospective case note and database review of children admitted to our tertiary unit with a parapneumonic effusion or empyema from 2002 to 2007, compared with 2008 to 2009. For the latter period, we also compared the outcomes of those with a bronchopleural fistula to those without. Results: During the 8-year period, 310 children were admitted. In the first 6 years, the frequency of air leaks was 1% (2/258) rising to 33% (16/49) in the last 2 years (P < 0.0001). Three children were excluded as their fistulas were possibly iatrogenic. This was associated with a significant increase in median hospital stay (7 vs. 10 days, P < 0.0001) and surgical intervention rate (2% vs. 14%, P = 0.001). In the latter 2 years, S. pneumoniae serotype 3 was identified in 10/16(91%) of those with a bronchopleural fistula compared to 1/33(3%) of those without. Conclusions: The frequency of bronchopleural fistulas increased markedly in the 2 years 2008-2009. Although these cases were associated with pneumococcal serotype 3 infection, which was not covered by the heptavalent pneumococcal vaccine Prevenar (R) in use at that time, we do not know whether the increased incidence of fistulas was due to a change in serotype 3 prevalence. Pediatr Pulmonol. 2011; 46:717-721. (C) 2011 Wiley-Liss, Inc.